Inspiring Heart Health in the ‘Stroke Belt’

Lenoir County is tucked into the eastern part of the state, about 75 miles east of Raleigh, with a population of around 57,000. If you’re headed to the coast, you’re likely to pass through.

“We welcome everybody with open arms,” said Laura Lee Sylvester, the president of the Kinston-Lenoir County Chamber of Commerce. “That’s what makes us stand out – we really take care of each other, no matter who you are or where you live.”

The tight-knit community is also facing a health crisis. Located in what is recognized as the “stroke belt,” its residents experience significantly higher rates of cardiovascular disease, stroke and obesity rates compared to other parts of the state and nation.

Alice Ammerman, a professor of nutrition in public health and director of Carolina’s Center for Health Promotion and Disease Prevention (HPDP), took notice. She and her colleagues reached out to county health officials to learn more about the county’s specific needs and the initiatives already in place, and for nearly five years now, this community has been the focus of Heart Healthy Lenoir.

The project is a community-based partnership of Carolina’s HPDP, the county and East Carolina University, and funded by the National Institutes of Health. It includes multiple initiatives to help Lenoir County residents live healthier lives and researchers collect the kinds of information that could affect change statewide.

“The people of Lenoir County have such a commitment to improving health, and they also approach things with a spirit of collaboration and partnership that’s helped accomplish many goals,” said Ammerman. “We’ve tried to help create a healthier environment rather than imposing restrictions, so that the healthy choice is the easy choice.”

Collaboration, not imposition

The center, which has projects in nearly all 100 counties across the state, takes a community-based approach to making a difference, one that works within the context of local culture to inspire lasting change.

Finding the most effective ways to tackle Lenoir County’s cardiovascular disease problem was a process of inclusion. A local advisory committee of health professionals, researchers, residents and other community partners, including Sylvester, convened to guide the process.

“I call them ‘The Dream Team,’” said Ammerman. “We needed to figure out how to do this in a way that would fit the community culture, designing programs and strategies that would be long-term, rather than making a big splash that can’t be sustained.”

Three interrelated studies with more than 650 participants emerged: a lifestyle intervention initiative to reduce heart disease risk and disparities in risk; a practice-based, enhanced-care intervention for hypertension that works with both patients and health professionals; and a genetic predispositions and genomic signatures study.

Preliminary data have shown positive results. Blood pressure is, by and large, on the decline, and so is weight. Changes – measurable and immeasurable – have been felt throughout the county, said Sylvester, who participated in some of the lifestyle change sessions offered by Heart Healthy Lenoir.

She considers it the chamber’s role to advocate for not only strong local businesses, but also a strong, healthy community.

“We’ve got problems here with childhood obesity, stroke and hypertension, the kinds of things that are going on in other parts of North Carolina, too,” said Sylvester. “Part of our mission at the chamber is to make sure we’ve got healthy citizens, because we know that healthy citizens bring economic development, and it makes for a better community.”

Not ‘The diet police’

Ammerman teaches public health entrepreneurship at Carolina in addition to nutrition policy. She’s aware of the business side of things, where radical change can mean lost customers.

She said her team tries hard not to be seen as the diet police. In working with Lenoir County restaurants, they have encouraged restaurateurs to better market their healthier options rather than making radical changes in their menus.

“We want restaurants to look at what they are already doing to promote health and pull it forward a bit more, give incentives to customers to make a better choice when they can,” she said.

See the Heart Healthy Lenoir team's recent experience at the 2014 Kinston BBQ Festival on the Neuse:

In her expert opinion, pork barbecue – a Southern staple for most of the state – still has a place at the table. This is good news for a community that has for three decades hosted the N.C. BBQ Festival on the Neuse in Kinston.

“I’ve always pushed back on the idea that Southern food is bad for you,” she said. “We’ve tried to make it clear that we’re not here to make people eat cardboard. We can work together on almost anything to make it healthy, if you do it in the right context.”

To prove the point, she has participated in and cooked at the long-running barbecue festival in Kinston three years in a row.

The first year, Ammerman and the Heart Healthy Lenoir team offered free taste testing of their own version of eastern North Carolina barbecue – pulled pork with a Southern vegetable base and a vinegary eastern style barbecue sauce over brown rice. Tasters looked skeptical, but ultimately gave it a big thumbs up.

A changing scientific view that includes more fat – the right kind of fat – in the diet allows more freedom in what is considered healthy. “This has actually opened the door for things like barbecue and hushpuppies,” she said.

At this year’s festival, Ammerman debuted her heart-healthy hushpuppies, a tried-and-tested recipe that enriches the batter with a mix of whole wheat and white flour, cornmeal, yellow grits, nuts and chopped vegetables. Instead of frying the hushpuppies in traditional lard or shortening, Ammerman drops the dough into heated vegetable oil for a heart-healthy hushpuppy.

“Barbecue and hushpuppies can both be part of a healthy diet if you use good quality oil and slip in some vegetables, nuts and whole grains,” she said, “and you don’t have to sacrifice taste.”

As the project is reaching the end of its funding, Ammerman is hopeful that community partners can adopt many of the strategies and programs to promote long-term change. Her team is also hopeful for additional funding to continue testing innovative approaches for scaling up the work to reach more people.

Sylvester is hopeful, too.

“We’re trying to educate people on a healthier way to live, and our work is not finished,” she said. “We’ve got to make sure that healthier options are accessible to everyone in the community, no matter where they live. We are dedicated to that.”


Alice's Heart Healthy Hushpuppies

To learn more about the center’s projects all over the state, visit